title: Brace or no-brace after ACL graft? Four-year results of a prospective clinical trial.
abstract: OBJECTIVE
  A controversial discussion is held on using stabilizing knee braces after anterior cruciate ligament (ACL) surgery. The current study investigated the influence of a stabilizing knee brace on results after ACL reconstruction using patellar tendon autografts.
  
  
  METHODS
  A prospective randomized study was started including 64 patients divided into two equal groups and treated with or without a stabilizing knee brace for 6 weeks post-operatively. A follow-up examination 4 years after operation comprised IKDC 2000, KT1000 measurement, a visual analogue pain scale (VAS; scores 0-10) and radiographic evaluation. The t test for independent and paired samples and the Pearson's Chi-square test were used for statistical analysis (p < 0.05). The primary endpoint was the difference in IKDC classification.
  
  
  RESULTS
  Eighty-one per cent of the patients were examined 4 years post-operatively. IKDC 2000 subjective (brace group 90.5 ± 8.9, braceless group 93.2 ± 6.1) and objective results (brace A 30%, B 56%, C 16%; braceless A 32%, B 48%, C 20%) and instrumental measurement of anteroposterior laxity with KT1000 (brace 0.6 ± 2.4 mm, braceless 1.8 ± 3.4 mm) showed no significant differences. VAS pain results were significantly better in the braceless group at 1.0 ± 1.2 versus 1.9 ± 1.4 under sports activity or heavy physical work (p = 0.015). There were no radiographic differences concerning osteoarthritic findings and tunnel widening between the groups.
  
  
  CONCLUSIONS
  Post-operative treatment with a stabilizing knee brace after ACL replacement showed no advantage over treatment without a brace at 4-year follow-up. The use of a knee-stabilizing brace after isolated ACL reconstruction with autologous patellar tendon graft is not recommended.
  
  
  METHODS
  II.
authors.affiliation: Department of Orthopedic and Trauma Surgery, Albert Ludwig University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany, hermann.mayr.ocm@gmx.de.
authors.forename: Hermann O
authors.initials: HO
authors.lastname: Mayr
authors.forename: Paul
authors.initials: P
authors.lastname: Stüeken
authors.forename: Ernst-Otto
authors.initials: EO
authors.lastname: Münch
authors.forename: Morris
authors.initials: M
authors.lastname: Wolter
authors.forename: Anke
authors.initials: A
authors.lastname: Bernstein
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Suedkamp
authors.forename: Amelie
authors.initials: A
authors.lastname: Stoehr
mesh_terms: D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D001915:Braces; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000601:surgery / Q000637:transplantation; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult